Medicaid Monitor
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Medicaid Monitor
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Indiana Capital Chronicle

22 stories

State Policy·IN·3d ago

Indiana Provider Warns Proposed ABA Limits Threaten Autism Care

In an Indiana Capital Chronicle commentary, an autism care provider argues that Indiana FSSA's proposed Medicaid policy changes to applied behavior analysis (ABA) therapy would harm children with autism. The author says FSSA proposed a lifetime cap on comprehensive ABA treatment hours and new supervision requirements last spring, following a 2024 federal review that flagged alleged improper payments to Indiana autism therapy providers. The author contends rising Medicaid spending reflects increased, earlier diagnoses rather than fraud, and warns the changes could cut off medically necessary care for roughly 40,000 Hoosier children on Medicaid who rely on ABA. The piece urges policymakers to pursue genuine fraud enforcement without restricting access to individualized, evidence-based treatment.

State Policy·IN·6d ago

Indiana Projects $5.3 Billion in Reserves by June 2027

Indiana closed fiscal year 2026 with nearly $4 billion in reserves and projects $5.3 billion in reserves by June 30, 2027 — 22% of revenues — as monthly collections have exceeded forecasts for ten consecutive months. Not all reserves are available for new spending: the total includes dedicated funds for Medicaid contingency ($274.7 million), state tuition ($739.6 million), and the Rainy Day Fund ($1.12 billion), and over $1.1 billion may be needed to reimburse the highway fund for the summer gas tax holiday. If reserves exceed 12.5% of appropriations in 2027, state law triggers an automatic taxpayer refund. The state's FY 2026-2027 budget cut real spending by 7% after April 2025 revenue forecasts fell short; legislators may revisit those cuts if the December 2026 forecast shows continued growth.

State Policy·IN·10d ago

Indiana FSSA Issues RFP for Second Short-Term Residential Facility for Disabled Adults

The Indiana Family and Social Services Administration issued a request for proposals for a provider to operate a 10-20 bed short-term residential facility for intellectually disabled adults with severe behavioral, psychiatric, or medical needs. The facility would replace a co-ed facility that closed in 2024 and address a service gap, particularly for women, as Indiana's only existing comprehensive rehabilitative management needs facility serves men only. The current per diem rate for such facilities is $703. Disability advocates have raised concerns that the new facility, combined with recent changes to Medicaid waiver assessments that have resulted in higher denial rates, could signal a shift toward institutionalization rather than community-based care.

State Policy·IN·12d ago

Indiana Medical Frailty Definition Unfinished Three Months Before Work Requirements Start

Indiana's Family and Social Services Administration has not finalized its medical frailty exemption criteria for Healthy Indiana Plan (HIP) work requirements set to begin in three months. The exemption will determine which HIP enrollees — able-bodied adults ages 19-64 — are excused from work requirements due to medical conditions that prevent compliance. The delay creates uncertainty for thousands of low-income enrollees and health plans administering HIP. Medical frailty definitions are critical because they determine who faces coverage loss if work requirements are not met versus who receives an automatic exemption.

Industry·IN·26d ago

Indiana Launches $68 Billion Medicaid Managed Care Procurement for 1.5 Million Enrollees

Indiana has issued a procurement for its Medicaid managed care program covering approximately 1.5 million enrollees, representing $68 billion in total contract value. The RFP will determine which health plans deliver Medicaid services to Hoosiers under managed care arrangements. Contract awards will shape the state's Medicaid delivery system for the coming contract period. The procurement represents one of the largest Medicaid managed care procurements nationally and will directly affect existing MCO contracts, provider networks, and care delivery infrastructure across Indiana.

State Policy·IN·34d ago

Indiana Expands CCBHC Model to 35 Counties, Aims to Reduce Competency Restoration Costs

Indiana implemented Certified Community Behavioral Health Clinic coverage across eight centers in 35 counties in 2025, following Senate Enrolled Act 1 passed in 2023. The program aims to reduce competency restoration referrals to state hospitals, which currently cost an average of $100,000 per person. Early results show reductions in hospitalizations and incarcerations among participating centers. The state has 57 counties remaining without CCBHC coverage.

State Policy·IN·47d ago

Indiana Federal Grant Funding Drops $700M in Latest Fiscal Year

Federal grant funding to Indiana declined by more than $700 million in the most recent fiscal year. When Medicaid funding is excluded from the calculation, the drop in competitive federal grants reaches double digits. The article does not specify whether the Medicaid decline reflects state policy decisions, enrollment changes, or federal funding formula adjustments. The timing and operational impact on Indiana's Medicaid program are not detailed in the available content.

State Policy·IN·52d ago

Indiana Lawmakers Seek Audit After Medicaid Disability Waiver Denials Jump to 6%

Democratic lawmakers in Indiana are demanding an independent audit of interRAI, an assessment tool the state's Family and Social Services Administration began using in January 2026. Disability waiver denials spiked to 6% this year from under 1% previously. The timing and scale of the increase has raised questions about the tool's calibration and impact on beneficiaries who need long-term services and supports. This matters for states using or considering similar standardized assessment tools for LTSS eligibility determination.

State Policy·IN·53d ago

Indiana Medicaid Work Requirement Affects 300,000 Enrollees Starting January 2027

Indiana's Medicaid work requirement takes effect January 1, 2027, affecting an estimated 300,000 low-income enrollees. State officials confirmed the mandate applies to new applicants and existing members renewing coverage in January, but compliance systems and exemption procedures remain incomplete with the first deadline less than two months away. The requirement will impact non-exempt adults enrolled in Indiana's Medicaid expansion population. State agencies and managed care plans must finalize tracking, verification, and disenrollment protocols before implementation.

State Policy·IN·54d ago

Indiana Plans Federal Waiver to Restore HIP Cost-Sharing for Adult Enrollees

The Indiana Family and Social Services Administration will seek a five-year CMS waiver to reinstate cost-sharing requirements for able-bodied adults enrolled in the Healthy Indiana Plan under a new HIP 3.0 iteration. The waiver would revive a modified version of Indiana's previous copayment model for this population. The timing of the waiver submission and CMS review process has not been specified. This represents a return to Indiana's earlier HIP approach requiring enrollee contributions, which had been modified or suspended under previous waiver terms.

State Policy·IN·55d ago

Indiana Prepares Medicaid Beneficiaries for Work Requirements Starting January 2027

Indiana's Family and Social Services Administration is deploying outreach tools, including texts and town halls, to prepare Healthy Indiana Plan (HIP) enrollees for new work requirements. The requirements take effect January 1, 2027, and will apply to both new applicants and current members eligible under HIP, the state's Medicaid expansion program. The state is providing advance notice and education to help beneficiaries understand compliance obligations before the policy goes live. This implementation affects Indiana's Medicaid expansion population and could influence enrollment and coverage continuity for working-age adults.

State Policy·IN·59d ago

Indiana Medicaid Returns $310 Million Surplus to State General Fund

Indiana's Family and Social Services Administration returned $310 million to the state general fund this year, reversing a prior $1 billion Medicaid deficit. FSSA Secretary Mitch Roob attributed the turnaround to agency reforms including regular financial reviews and must-return mailers. The surplus reflects improved program integrity and budget management within Indiana's Medicaid program. This development demonstrates how operational reforms can transform state Medicaid finances from deficit to surplus.

State Policy·IN·60d ago

Indiana to Implement Medicaid Work Requirements and New Eligibility Rules Over Next 18 Months

Indiana will implement new Medicaid work requirements and eligibility rules over the next 18 months, following a redetermination period that already removed hundreds of thousands of beneficiaries from coverage. The changes represent a second phase of enrollment restrictions after the unwinding of pandemic-era continuous coverage protections. The new requirements will determine whether additional beneficiaries lose Medicaid coverage. State agencies and managed care plans operating in Indiana will need to adjust operations to support compliance tracking and member communications around the work requirement policy.

State Policy·IN·61d ago

Indiana Families Report Coverage Losses During Medicaid Redetermination Process

Indiana families are losing Medicaid coverage despite submitting required documentation during the state's ongoing eligibility redetermination process. Parents report receiving termination notices after complying with verification requests, with some experiencing gaps in coverage for children despite resubmitting paperwork. The coverage losses appear tied to administrative processing issues during Indiana's unwinding of pandemic-era continuous enrollment protections. Affected families face immediate barriers to accessing care and prescription medications while attempting to restore coverage through state appeals processes.

State Policy·IN·62d ago

Indiana Families Navigate Ongoing I/DD Waiver System Changes Since Late 2023

Indiana's Medicaid waiver system for individuals with intellectual and developmental disabilities has undergone continuous changes since late 2023, including new service rules, case management restructuring, and modified eligibility requirements. Families and providers are managing multiple policy shifts simultaneously while maintaining care continuity. The accumulated changes affect how services are authorized, delivered, and documented across Indiana's I/DD waiver programs. These reforms create operational uncertainty for MCE plans administering waiver services and providers contracted to deliver them.

State Policy·IN·62d ago

Indiana Medicaid Enrollment Drops 18.5% in One Year, Raising Uninsurance Concerns

Indiana's Medicaid enrollment declined by 343,000 people (18.5%) between June 2025 and June 2026, falling from 1.86 million to 1.51 million enrollees — one of the steepest drops nationally. The decline follows the end of Medicaid continuous coverage protections and completion of post-PHE redeterminations. Hospitals, providers, and advocates are concerned about rising uninsurance rates as former enrollees lose coverage. The enrollment reduction affects provider revenue, hospital uncompensated care levels, and managed care plan membership and capitation.

State Policy·IN·65d ago

Indiana Medicaid to Cover GLP-1 Medications for Obesity Under Federal Initiative

Indiana Governor Mike Braun directed the state's Family and Social Services Administration to cover GLP-1 medications for obesity through a federal Centers for Medicare & Medicaid Innovation Center initiative. The policy will affect 1.9 million Medicaid enrollees in Indiana. The directive was issued July 30, 2026, though specific implementation timelines were not provided in the announcement. This marks a significant expansion of pharmacy benefits for Indiana's Medicaid population, as most state Medicaid programs have historically excluded coverage of anti-obesity medications.

Federal Policy·79d ago

SNAP and Medicaid Eligibility Changes May Reduce School Meal Program Participation

Federal changes to SNAP and Medicaid eligibility could reduce the number of students qualifying for free school meals under USDA's Community Eligibility Provision. USDA uses enrollment in means-tested programs including Medicaid as a benchmark to determine which high-poverty school districts can offer universal free meals without collecting individual applications. Reductions in SNAP or Medicaid enrollment—whether through eligibility restrictions, administrative changes, or state policy decisions—could push schools below CEP thresholds, forcing districts to return to individual meal applications and potentially reducing meal participation among eligible low-income students. The timing of these changes depends on pending federal SNAP and Medicaid policy actions.

State Policy·IN·88d ago

Indiana to Implement Medicaid Work Requirements Starting January 2027

The Indiana Family and Social Services Administration released implementation details for Medicaid work requirements affecting able-bodied adults ages 19-64 enrolled in the Healthy Indiana Plan. Requirements begin January 1, 2027, with early compliance rules for new applicants and an 80-hour monthly work obligation for current enrollees. The policy applies to HIP members without exemptions such as disability, pregnancy, or caregiver status. Indiana becomes one of the first states to move forward with work requirements following recent federal policy shifts, requiring managed care organizations to track and report member compliance.

State Policy·IN·89d ago

Indiana Maintains Medicaid Funding Block to Planned Parenthood After Federal Ban Expires

Planned Parenthood remains excluded from Indiana's Medicaid program despite the recent expiration of a federal prohibition on Medicaid payments to abortion providers for non-abortion services. The organization reports it is still unable to receive reimbursement for covered Medicaid services in Indiana. The continued funding block appears to rely on state-level policy even after federal restrictions lapsed. This affects Medicaid beneficiaries' access to family planning, preventive care, and other covered services through Planned Parenthood clinics in Indiana.

State Policy·IN·96d ago

Indiana Medicaid Enrollment Drops 174,000 Children in Three Months

Indiana lost 174,000 children from Medicaid between January and April 2025, a 20% decline that represents the steepest percentage drop in the nation, according to Georgetown University's Center for Children and Families. The state also recorded the third-highest absolute enrollment decline nationally during this period. This drop follows the end of continuous enrollment protections that were in place during the COVID-19 public health emergency. Indiana's redetermination process appears to be resulting in significantly higher disenrollment rates than most other states.

Federal Policy·IN·101d ago

Indiana Joins CMS Pilot Using Oracle AI to Detect Medicaid Fraud

The Indiana Family and Social Services Administration is participating in a CMS pilot program that provides free access to Oracle's artificial intelligence software for Medicaid fraud detection. The AI will analyze claims data to identify suspect billing patterns including upcoding and other fraudulent activities. CMS is offering the software at no cost to state Medicaid agencies as part of a federal initiative to strengthen program integrity using advanced analytics. This represents a shift toward automated fraud detection that could affect provider billing scrutiny and audit patterns.

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